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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 3, 336-342.
doi: 10.1302/0301-620X.90B3.19408  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics

D. J. Cuff, MD, Consultant Orthopaedic Surgeon1; N. A. Virani, MD, Orthopaedic Resident1; J. Levy, MD, Consultant Orthopaedic Surgeon2; M. A. Frankle, MD, Consultant Orthopaedic Surgeon1; A. Derasari, BS, Medical Student3; B. Hines, DO, Consultant Orthopaedic Surgeon4; D. R. Pupello, BS, Research Staff1; M. Cancio, MD, Consultant Physician5; and M. Mighell, MD, Consultant Orthopaedic Surgeon1

1 Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, Florida 33637, USA.
2 Orthopaedic Institute Holy Cross Hospital, 4275 North Federal Highway, Ft Lauderdale, FL 33308, USA.
3 University of South Florida, College of Medicine, 12901 Bruce B. Dawns Blvd, MDC 2, Tampa, Florida 33612, USA.
4 Memorial Hospital, York, 325 S. Belmont St, PA 17405, USA.
5 Infectious Disease Associates of Tampa Bay, 4 Columbia Drive #820, Tampa, Florida 33606, USA.

Correspondence should be sent to Dr M. A. Frankle; e-mail: frankle{at}pol.net

We retrospectively reviewed 21 patients (22 shoulders) who presented with deep infection after surgery to the shoulder, 17 having previously undergone hemiarthroplasty and five open repair of the rotator cuff. Nine shoulders had undergone previous surgical attempts to eradicate their infection. The diagnosis of infection was based on a combination of clinical suspicion (16 shoulders), positive frozen sections (> 5 polymorphonuclear leukocytes per high-power field) at the time of revision (15 shoulders), positive intra-operative cultures (18 shoulders) or the pre-operative radiological appearances. The patients were treated by an extensive debridement, intravenous antibiotics, and conversion to a reverse shoulder prosthesis in either a single- (10 shoulders) or a two-stage (12 shoulders) procedure.

At a mean follow-up of 43 months (25 to 66) there was no evidence of recurrent infection. All outcome measures showed statistically significant improvements. Mean abduction improved from 36.1° (SD 27.8) pre-operatively to 75.7° (SD 36.0) (p < 0.0001), the mean forward flexion from 43.1° (SD 33.5) to 79.5° (SD 43.2) (p = 0.0003), and mean external rotation from 10.2° (SD 18.7) to 25.4° (SD 23.5) (p = 0.0037). There was no statistically significant difference in any outcome between the single-stage and the two-stage group.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General